Nasal septal hematoma

Background

• Requires immediate incision and drainage to prevent nasal septum necrosis
  • Can lead to saddle nose deformity, nasal septum abscess
• Suspect septum abscess in pt who presents late after facial trauma with systemic symptoms
• Ensure thorough examination of both nares - Nasal septum cartilage easily fractures (form bilateral hematomas)

• Adults present with significant facial trauma and nasal fracture

• Common symptoms in peds, usually within first 24-72 hrs with even minor nasal trauma, include:
  • Nasal obstruction (95%)
  • Pain (50%)
  • Rhinorrhea (25%)
  • Fever (25%)

Treatment

1. Place lidocaine-soaked cotton pledgets in nose for 5min
2. Achieve visualization with nasal speculum
3. Make horizontal incision superficially through the mucosa and the perichondrium
   1. Ensure that you do not incise the cartilagenous septum
4. Evacuate clot with Frazier suction or forceps
5. Insert single 1/8in iodoform gauze wick into the incision to avoid premature closure
6. Perform b/l anterior nasal packing w/ nasal tampons coated w/ topical abx
   1. Prevents reaccumulation of clot and keeps septum midline
7. Give oral abx (cover S. aureus, H. flu, S. pneumo)
   1. Amoxicillin/clavulanate for uncomplicated
   2. Clindamycin if abscess suspected

Disposition

• Discharge w/ 24hr ENT or ED follow-up

See Also

• Nasal fracture

Source

• Tintinalli
• eMedicine